MEDICAL KNOWLEDGE:

• Apply and reinforce knowledge of basic sciences, especially anatomy and pathophysiology, to the understanding, presentation and treatment of common surgical diseases.

• Identify how and when evidence – based information impacts care of surgical Patients and changes in management, e.g., breast conservation surgery vs. mastectomy.

• Identifytheimpactof cost: benefitratiointheimplementationofnew new technologies in the surgical arena, e.g., laparoscopic and robotic surgery, laser technologies.

• Identifyat an elementary stage the importance of third-party payers and theirimpact on surgicalcare, e.g., the early discharge ofpost-operative patients operative patients, the trend to ambulatory surgery etc.

• Recognize the importance of ancillary services in the continuum of careof surgical Patients: Visiting nurse programs, rehabilitation services etc.

• Through an understanding of the core topics (listed below), apply the body of surgical knowledge to clinical analysis and problem solving.
• Use appropriate on-line resources for up-to-date information to augment text book knowledge for surgical case and topic presentations.

CLINICAL SKILLS

• Apply the principles of surgical practice to common conditions, especially with regard to decisions of operative and non-operative management.

• Collect the appropriate clinical, laboratory and ancillary information towards establishing a working diagnosis and list of differential diagnoses.

• Delineate for the common surgical conditions the appropriate, cost-effective tests available for the expeditious diagnosis in common surgical disease.

• Develops specific communication skills by accessing and completing module 17 (Informed Decision-making) and module 35 (Discussing Medical Error) of the Drexel University communications course @ doc.com.

• Identify the importance and details of obtaining informed consent for operations/procedures, with emphasis on risks, benefits, and alternatives

• Observe when possible the manner in which attendings/ consultants have difficult discussions with patients and family, e.g., complications of operations, need for reoperations, futility of care etc.

• Identify the importance of communication in multidisciplinary care of surgical patient in an environment of mutual respect.

• Demonstrate the ability to do proper sterile preparation and technique.

PROFESSIONAL BEHAVIOR

• Function as a part of the surgical team to which assigned, being responsible to be punctual, involved and in the appropriate arena, which may include the OR, ED, ICU and floors at various times.

• Demonstrate proper behavior in operating room at all times with strict observance of all rules.

• Realize the limits of ones position on the team so as not to engage patient and family in discussions about their care beyond the limits of a student’s position.

• Recognize ones own limitations by seeking supervision sequentially at levels from residents to attendings/consultants.

• Demonstrate sensitivity whenever cultural issues affect surgical practice and interventions, e.g., use of blood in a Jehovah’s Witness, platelet dysfunctions from herbal remedies, etc.

Surgery Guidelines

• Length: twelve weeks
• An orientation at the start of the clerkship should be done by the clerkship director. This
  should include a discussion of the expectations and responsibilities of the clerk, the
  general department, the student schedule and assignments to residency teams and
  preceptors. The school clinical manual should be issued as part of the orientation process.
• Site: predominately general surgical wards with inclusion of ICU, OPD, ED experience and
  subspecialty experiences. Students must attend operations performed on their patients.
• The twelve week rotation includes exposure to the subspecialties of urology, anesthesia,
  orthopedics, and others that are available, including ENT and ophthalmology.
• Students must take night, weekend, and holiday call with their teams.
• Attending rounds for house staff and students should be done at least three times a week.
• A full schedule of teaching conferences including grand rounds, subspecialty conferences
  and didactic sessions pertinent to the needs of the students.
• Direct preceptor supervision of the students at least three hours per week to include
  case presentations by the students with bedside rounds including physical examination
  and interactive sessions.
• A minimum of five clinical write-ups or formal presentation to include a complete
  database and problem list with its assessment and diagnostic and therapeutic plan.
  Critique of the write-ups is provided to the students.
• Electronic patient logs are to be maintained and up do date at all times.
• Electronic patient logs will be periodically inspected by the clerkship director at mid-
  rotation, end of core oral exam and by the deans and the chair of surgery during their site
  visits to assure a reasonable case mix.
• Students will be responsible to review basic anatomy, pathology and physiology of all
  surgical problems encountered.
• Students will be responsible for the requirements and recommendations in the
  appendices containing the Log Book of Manual Skills and Procedures.

Evaluations:

• There will be evaluations by each service rotated through during the 12 weeks utilizing the school’s evaluation forms.

• Five H&P’s will be reviewed and evaluated.
• Mid-core evaluations and feedback sessions will be done one-on-one with each student including review of electronic patient logs. The appropriate document will be included
  in the student’s permanent folder.

• An end-of-core oral examination will be done with each student and include a review of the electronic patient log.

• An end-of-core written examination based on the core topics below and generated by the SGU Department of Surgery will be administrated by the hospital under strict
  examination conditions.

CORE TOPICS

In addition to general medical knowledge students will be required to demonstrate knowledge in the followed surgical areas that will form the basis for evaluation in the written exam at end of clerkship.

1. Module 1: Shock

• Define types of shock: hypovolemic, septic, neurogenic, anaphylactic, cardiogenic.
• Recognize the clinical signs of hypovolemic shock and relate them to the underlying
  pathophysiological process. List the classification of hypovolemic shock.
• Describe the critical objective measurements used to monitor the patient in shock.

2. Module 2: Trauma

• Explain the ATLS teaching of primary and secondary survey in trauma patients.
• Delineate the management of patients with blunt and penetrating abdominal and
  thoracic trauma.

3. Module 3: Head Injuries

• Explain the Glasgow coma score.
• Delineate the principles of early management of head injuries including epidural and subdural hematomas.

4. Module 4: Burns

• Classify burns according to staging and etiology.
• Estimate area of burns using the rule of nines.
• Explain the resuscitation of the burn patient-the crystalloid formula.
• Outline the basic principles of burn wound care.

5. Module 5: Acute Abdomen

• Outline the pathophysiology, clinical presentations and consequences of acute
  peritonitis- localized and generalized.
• Describe diagnosis and treatment of acute appendicitis, acute
  cholecystitis, and acute pancreatitis.
• Become conversant with other causes of acute abdomen: biliary colic, acute
  diverticulitis, perforated ulcer, other perforated viscera, and cholangitis.

6. Module 6: Intestinal Obstruction

• Differentiate large and small bowel obstruction, with common causes
• Differentiate bowel obstruction from paralytic ileus.
• List the pathophysiology of fluid and electrolyte disturbances in small bowel obstruction.
• List management options in intestinal obstruction, including partial small bowel
  obstruction, small bowel obstruction, and large bowel obstruction.

7. Module 7: Gastrointestinal Bleeding

• List the etiologies of upper and lower GI bleeding.
• Acquire detailed knowledge of the emergency management of GI bleeding and the principles of resuscitation.

• Delineate the workup of GI bleed including endoscopy, bleeding scans, and angiography.

• List the indications for surgical intervention in upper and lower GI bleeding.
• Describe the pathophysiology of portal hypertension and principles of management.

8. Module 8: Common GI Malignancies

• Review the pathology and modes of spread of malignancies.
• Outline staging, screening, presentations and management of cancer of the colon,
  rectum, pancreas and stomach.
• Review relevant anatomy of the GI tract to fully appreciate segment resections seen in the operating room
• Acquire an overview of prognoses of the common malignancies.

9. Module 9: Hernias

• Define hernia and describe the different types of abdominal wall hernias.
• Demonstrate understanding of incidence, etiology, complications, operative risks,
  and failures to give proper advice to patients concerning care required for abdominal
  wall hernias.
• Outline the fundamentals of surgical hernia repair of various groin, umbilical, and
  ventral hernias.
• Define terms related to abdominal wall hernias ¾ reducible, irreducible, incarcerated,
  and strangulated.

10. Module 10. Surgery of the Breast

• Discuss the frequency of the various masses of the breast and their appropriate
  treatment.
• Describe the specific signs associated with cancer of the breast.
• Outline the reasonable management for benign and malignant disease of the
  breast including new modality-sentinel node biopsy.

11. Module 11: Colo-rectal conditions

• Describe common ano-rectal conditions: hemorrhoids, fissure-in-ano, fistula-in-ano,
  perianal abscess, ischio-rectal abscess.

12. Module 12: Peripheral Arterial Disease

• Describe signs and symptoms of abdominal aortic aneurysm. Describe the tests
  necessary to reach that diagnosis. Outline the management of abdominal aortic
  aneurysm.
• Describe the pathophysiology of peripheral arterial occlusive disease.
  
• Describe the signs and symptoms of cerebral transient ischemic attacks and outline
  the tests used for diagnosis; know the principles of carotid artery disease.
• Describe the clinical course of thromboembolic disease, and discuss the methods of
  management.

13. Module 13: Venous Disease

• Review the venous systems of the lower extremity, the significance of the musle pump
  and valvular incompetence.
• List the principles of management of varicose veins.
• Explain the pathophysiology of venous ulcers and the principle s of their treatment.
• Delineate the diagnosis and treatment of DVT, major DVT, post phlebitic syndrome,
  and PE.

14. Module 14: Thoracic Surgery

• Explain the work-up of a solitary lung mass
• List an overview of tumors in the chest by location
• Delineate the principles of surgical management of lung cancer
• List overview of benign and malignant esophageal conditions, including GERD.

15. Module 15: Transplant Surgery

• Get an overview of the status of transplant surgery in the USA and worldwide.
• Understand the immunological aspects of transplant surgery.
• Know the drugs commonly used in transplant surgery.

16. Module 16: Laparoscopic Surgery

• Identify the advantages and disadvantages of laparoscopic surgery, including some
  idea of the economics involved.
• Identify the trend of advanced laparoscopic techniques and robotic surgery.
  

17. Module 17: Bariatric Surgery

• Define obesity and morbid obesity.
• List the comorbidities associated with morbid obesity.
• List the principles of different modality of bariatric surgery-restrictive vs. malabsorbtive
• Explain the socioeconomics of bariatric surgery in USA, and worldwide.

18. Module 18: Endocrine Surgery

• Describe symptoms, signs and management of hyperthyroidism.
• Discuss evaluation of a thyroid nodule.
  
• Discuss evaluation of patient with hypercalcemia.
• Discuss pathophysiology of primary, secondary or tertiary hyperparathyroidism and
  surgical therapies.
• Discuss presentation, investigation and management of pheochromocytoma.
• Discuss features of multiple endocrine adenopathy syndrome associated with
  pheochromocytoma and compare with other MEN syndromes, and their surgical
  treatment.

SURGICAL SUBSPECIALTIES

ANESTHESIOLOGY:

• Discuss the Pre- Op Evaluation:
• Specific chronic diseases states
• DM, Hypertension, ASHD, (IDH)
• Discuss the Intra-Op: -Induction of anesthesia—methods/risks
• Intubation and airway management
• Care and monitoring of unconscious patient
• Blood and fluid management
• Local, regional, general anesthesia
• Discuss Post-op:
  
• Monitoring in PACU (recovery room):
  
• General, regional anesthestics, pain management
  
• Early/late complications
  
• List common drugs used  in Anesthesia :  
  • Local anesthetics agents -- toxicity
  • Induction agents, including paralyzing agents
  • Common general anesthetic agents

ORTHOPEDICS:

• Delineate the process of fracture healing.

• List common fractures seen in practice – long bones and pelvis.
• Outline the principles of immobilization of bones and joints in trauma.
• Delineate the diagnosis and treatment of low back pain and sciatica.

 

UROLOGY

• List the common symptoms in the presentation of urinary problems.
• List the common urological problem encountered in clinical practice.
• Identify the methods used to treat ureteric and renal stones.
• Outline screening diagnosis and prescription prostate disease.

OPHTHALMOLOGY:

• Draw the findings of a normal fundus.
• List the fundoscopic changes associated with common clinical conditions, e.g. HTN & DM.
• Explain the importance of pupillary size and reactions in common clinical conditions, diagnosis, head trauma.
• Review anatomy of the eye.

 
EAR/NOSE/THROAT:

• Review relevant clinical anatomy of ear/nose/throat.
• Outline common conditions of ear including cerumen, foreign body, perforated tympanic membrane, otitis media.
• Outline common conditions of nose/sinus: deviated septum, hyper-trophic turbinates, acute and chronic sinusitis.
• Outline common conditions of throat: tonsillitis with indications for tonsillectomy, sleep apnea.

SURGERY READING LIST

Students should use the most recent edition of the following basic required  short  textbook  for  the  surgical rotation. This includes materials that students will be responsible for in preparation for the written examination and are the two volumes of Lawrence’s textbooks:

REQUIRED

Essentials of General Surgery and Essentials of Surgical Specialties
Lawrence, Williams and Wilkins

RECOMMENDED

Students are also encouraged to do further reading for interest, as reference, for
preparing talks, etc. Suggested additional sources are:

• Principles of Surgery
  Schwartz, McGraw Hill
• Early Diagnosis of the Acute Abdomen
  Cope, Oxford University Press
• Lecture Notes in General Surgery
  Ellis and Calne

Journals:

• British Journal of Surgery

Websites:

• eMedicine.com
  
• doc.com (Drexel University communications skills-modules 17 & 35)
• Wise MD.com